Provider Demographics
NPI:1790245678
Name:SWAIN, SUZANNE MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21240 N 36TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8387
Mailing Address - Country:US
Mailing Address - Phone:480-729-1205
Mailing Address - Fax:
Practice Address - Street 1:3300 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-3030
Practice Address - Country:US
Practice Address - Phone:602-639-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225874363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health